Contrast-enhanced ultrasound of hepatocellular carcinoma: correlation between enhancement pattern and cellular differentiation on histopathlogy

Abstract

The aim of this study was to evaluate and correlate the enhancement pattern of hepatocellular carcinoma (HCC) on contrast-enhanced ultrasound (CEUS) and tumour cellular differentiation on histopathology. Patients underwent hepatic CEUS, performed with SonoVue and contrast pulse sequencing. The correlation between enhancement time and enhancement level of the lesions in different vascular phases and tumour cellular differentiation was determined. The tumours were graded according to the Edmondson grading system. Then, diagnosis was obtained by histopathological examination following surgery or percutaneous ultrasound-guided biopsy. 189 patients with HCC were examined with CEUS and histopathological examination between 2003 and 2009: 159 had a solitary lesion (85 %), 24 had 2 lesions (12 %) and 6 had multiple lesions (3 %). The final histological grading of the tumours was as follows: 22, 114, 49, 4 grade I-IV, respectively. Significant differences were shown between the time that HCC become hypoenhancing or remained echogenic in late phase and tumour cellular differentiation (p = 0.006, p = 0.036). The timing of HCC becoming hypoenhancing was correlated with tumour cellular differentiation, with better differentiated HCCs washing out more slowly than poorly differentiated ones (p = 0.164, p = 0.113; p = 0.186, p = 0.070). The enhancement pattern of HCC by CEUS correlates with the cellular differentiation. In late phases, hyperechoic lesions are likely to be better differentiated, whereas hypoechoic lesion is more likely to be poorly differentiated.

Efficacy of Contrast-Enhanced Ultrasound Washout Rate in Predicting Hepatocellular Carcinoma Differentiation

“…With CEUS, real-time and repeated observations can be made, and US is more convenient than CT and MRI. It has been speculated that enhancement patterns may also be related to the cellular differentiation of HCC (Bhayana et al 2010;Iavarone et al 2010;Jang et al 2007;Liu et al 2007;Loria et al 2012;Nicolau et al 2004Nicolau et al , 2006Takahashi et al 2011). Nakashima et al (1999) reported that as HCCs increase in size and become increasingly dedifferentiated, the number of portal tracts decreases and the number of intratumoral arterioles increases.…”

Value of Perfusion Parameters for Differentiating Hepatocellular Carcinoma and Liver Metastasis With Hypervascularity and a Normal Hepatic Background on Contrast‐Enhanced Ultrasound Imaging

“…Bhayana et al reported that wash‐out in HCCs tended to occur later and often began longer than 90 seconds after contrast agent injection, whereas MLTs showed much faster wash‐out (<60 seconds). Other studies examining differences in the WT between HCCs and MLTs reported similar results . However, these results were based on qualitatively observing the differences in echogenicity between lesions and liver parenchyma that may have low intraobserver and interobserver reproducibility.…”

The prediction of microvascular invasion of hepatocellular carcinoma using multiple imaging modalities

“…The correlation between histologic grading and tumor enhancement washout time on CEUS has also been reported [13][14][15][16][17] . For example, Xu et al [14] analyzed the enhancement pattern of HCC using time-intensity curve.…”